CARE HOMES FOR OLDER PEOPLE
Orchard House 155 Barton Road Kettering Northants NN15 6RT Lead Inspector
Keith Charlton Unannounced Inspection 23rd January 2006 09:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Orchard House Address 155 Barton Road Kettering Northants NN15 6RT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01536 514604 01536 485599 daryl.wilson@btopenworld.com R Sons (Homes) Limited Mrs Daryll Louise Wilson Care Home 33 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (33), of places Physical disability over 65 years of age (10) Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The total number of service users must not exceed 33 No one falling within the category of DE (E) may be admitted to the home when there are already 6 persons of category DE (E) already accommodated in the Home. No one falling within the category of PD (E) may be admitted to the home when there are 10 persons of category PD (E) already accommodated in the home. To be able to admit the named person of category PD (Physical Disability under 65) named in variation application number V26790 dated 16/11/05 30/10/2005 3. 4. Date of last inspection Brief Description of the Service: Orchard House is located in a quiet residential area in Barton Seagrave, on the outskirts of Kettering. It is an extended detached property offering accommodation, in 26 single bedrooms and 3 double bedrooms, on the ground and the first floor, which can be accessed via stairs or a lift. There are extensive well-maintained and attractive grounds that are fully accessible to Service Users. Orchard House offers 32 places for older people over the age of 65 who require personal care and support due to age. Its registration includes the capacity to care for older people with physical disabilities and some with Dementia conditions. Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service user and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting two service users and tracking the care they received through looking at their records, discussion, where possible, with them and care staff and observation of care practices. This was an unannounced Inspection. The Registered Manager was on duty. Planning for the Inspection included reading the last inspection report and the homes service history. This information was used to plan the key areas to be inspected. The inspection involved talking to residents about their life in the home and reviewing a sample of care records to see how their care is planned. The Inspection took place between 09.50 and 14.55 and included a tour of the building, inspection of records and indirect observation of care practices. The Inspector spoke with seven residents, one relative, four members of staff and the Registered Manager. What the service does well:
There is a relaxed atmosphere in the home and staff welcome visitors. Relationships between residents and staff were generally observed to be friendly and all residents confirmed that staff in the home provide good care and generally good food. The staff spoken to were positive about providing a good service to residents. A staff member was observed to give a service user the opportunity to feed herself but then go back to check and assist when this was needed. A relative said that staff always welcomed her and thought the home was relaxed and care appeared very good. Staff are asked by the Registered Manager to read service users Care Plans to ensure they are aware of all needs. Staff are also asked to read the service’s Policies and Procedures to ensure that action follows good practice and is consistent. Service users said that the routines in the home are relatively flexible and residents are provided with opportunities to make choices rising and retiring and choices of food provided. A service user was observed to make
Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 6 a cup of tea for herself and staff said this had been Risk Assessed to ensure it was safe to do this. Facilities were found to be odour free and a domestic worker was very positive about providing a good service. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Please refer to the last Inspection Report EVIDENCE: N/A Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10 Service users needs are generally well met. EVIDENCE: Service users said that the care they received from staff was very good. Their care plans are generally detailed though some issues were not included – dates of health checks, food preferences, religious needs etc. One service user’s file was without Risk Assessments on identified needs of risk of falling and wandering. Medication is generally well managed, as records were generally detailed though there were a small number of gaps, which the Registered Manager was to follow up. Creams were not being recorded. The Registered Manager said she would devise a system to do this. The Registered Manager stated that senior staff are due to have refresher training on medication administration in the near future when the pharmacist has been changed. The medication trolley was not secured. The Registered Manager said arrangements are being made to carry this out. The Inspector observed staff to be mostly very friendly and helpful to service users during the inspection. On occasion staff used potentially demeaning terms such as ‘lovely’ and darling’ when addressing service users. The
Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 10 Registered Manager said this issue would be followed up and staff reminded to show respect at all times to service users. Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 Service users have a generally good lifestyle though activities need to be reviewed to provide more stimulation. EVIDENCE: Service users said that there were no rules and they could generally follow their lifestyles by rising and retiring as they chose, they could have breakfast in bed if they chose, they liked the food (though there was comment that food needs to be served hot as it was lukewarm often), and they could self medicate if they were safe to do so. A case tracking of on file showed a restriction for alcohol use though this was agreed with the Social Service Departments making the placement. One service user was seen to make tea for herself. Another said she made her own bed though staff assisted if she did not feel she could manage this. When the inspector entered lounges the TV was on but no one was watching. There were a number of comments that there were not enough activities on a day to day basis. Flower arranging was organised by staff for some service users. The Registered Manager said service users enthusiasm for activities was very variable. There is a system of recording what activities service users do though there were significant lengths of time between activities. The organisation of making up of a memory box of items significant for service
Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 12 users, particularly for service users with dementia, was discussed with the Registered Manager. Service users said that their visitors were welcome at any time. A relative confirmed this to be the case and said staff were very friendly and offered a hot drink when she visited. Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The complaints system is in place though not all staff understands how to protect service users from abuse. EVIDENCE: There is a Complaints Procedure, which is generally detailed though needed a minor amendment. A complaints book is in place which details the concern raised and action taken though the action was not fully detailed for the only formal complaint raised in 2003. Staff were asked as to the adult protection procedure and one staff generally found to understand this though another was unsure of the proper procedure – the Registered Manager is to set out a short written procedure to assist all staff to follow this. Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The premises are generally homely; some improvements are needed to easy chairs, the main lounge, bathrooms and paintwork to doorways and skirting. EVIDENCE: Service users generally spoke positively their bedrooms and these were found to be in a generally good condition. Facilities were seen to be mainly very clean and free from malodour although bathroom areas either lacked hand towels or toilet paper and locks and one bathroom window would not shut, letting in cold air. Some arms on easy chairs in the main lounge were threadbare and the lounge needed repainting. Some paintwork on doorways and skirting was heavily scrapped. Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 Service users needs are generally met by daytime staffing though a review of staffing in the evening is needed to ensure lower staffing levels cover all service users needs. Staff recruitment checks are generally in place. EVIDENCE: There were two Assistant Managers and two care assistants on duty at the time of the inspection with a cook and a domestic staff on duty with the Registered Manager. This is the normal staffing ratio until 6.00pm when this reduces to three care staff until the two waking night staff are on duty at 9.00pm. As there are a large proportion of service users with high dependency needs the Registered Manager needs to review evening staffing levels to ensure all service users needs are covered. There were some periods during the Inspection when the small lounge was unattended, with a service user with challenging behaviour threatening another service user. A review of staff supervision of this person is needed to ensure the protection of other service users. Staff records inspected showed proper recruitment practices were being followed except a reference not in place from the last employer of one staff. Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35,36,37,38 Health and Safety systems need strengthening, staff need to be regularly supervised and there needs to be greater focus on confidentiality issues. Recording of service users monies is good. EVIDENCE: Some service user monies records were checked and found to be in order with running balances, receipts and two signatures. The Registered Manager carries out annual staff appraisals but regular supervision in currently not taking place. Medication records were left on the medication trolley in the main lounge freely available to anyone who wanted to look at them. Staff are issued with a Health and Safety booklet. A Health and Safety Risk Assessment for safe working practices had been carried out last year. The Registered Manager said she was due to update this. Some identified issues
Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 17 had not received attention – e.g. locks on bathrooms and the parking area at the front of the home with potholes. A kitchen fire door not on an automatic closure was wedged open which was a Health and Safety hazard (an Immediate Requirements Notice was issued to deal with this). The water temperature was checked and found to be within the National Standard. Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 2 2 2 Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard OP18 OP19 OP27 Regulation 22 16 18 Requirement All staff need to understand the adult protection procedure. Facilities need to receive regular maintainace as identified. Staffing levels and supervision of service users needs to be reviewed to ensure all service users needs are covered. Staff must receive regular supervision. Confidentiality of service users records needs to be maintained. Health and Safety systems need to be reviewed to ensure service users are always protected. Timescale for action 23/04/06 23/04/06 23/02/06 4 5 7 OP36 OP37 OP37 18 17 13 23/04/06 23/01/06 23/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 20 No. 1 Refer to Standard OP12 Good Practice Recommendations The Registered Manager is recommended to implement an Activities Programme based on residents choices. Orchard House DS0000012879.V277145.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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